Deep Brain Stimulation Treatment Of Patients Research Articles

Short-Term Adverse Outcomes After Deep Brain Stimulation Treatment in Patients with Parkinson Disease

Despite ongoing progress in our understanding of long-term outcomes after neuromodulation procedures, acute adverse outcomes shortly after deep brain stimulation (DBS) treatment have remained remarkably limited. To identify risk factors associated with acute 30-day outcomes after DBS treatment in patients with Parkinson disease (PD). We evaluated patients who underwent DBS treatment for PD from 2005 to 2014 through the American College of Surgeons National Surgical Quality Improvement Program database. We used bivariate analysis and multivariate logistic regression to identify short-term postoperative outcomes, including 30-day complication, discharge destination, and unplanned readmission. Overall, 650 patients with PD underwent DBS procedures and complications were identified in 32 patients (4.9%). Of 481 patients who had complete discharge data, 18 patients (3.7%) were discharged to a facility and 16 patients (3.3%) experienced an unplanned readmission. Patients with PD who were obese (P= 0.045), who had preoperative anemia (P= 0.008), and who experienced longer operative durations (P= 0.01) had increased odds of postoperative complications. Inpatient status (P=0.001), dependent functional status (P < 0.001), and anemia (P= 0.043) were all associated with discharge to a facility other than home. Longer operative duration (P=0.013), anemia (P= 0.036), and dependent functional status (P = 0.03) were significantly associated with unplanned readmission. As expected, complications increased the likelihood of unplanned readmission (P < 0.001). This study provides individualized estimates of the risks associated with short-term adverse outcomes based on patient demographics and comorbidities. These data can be used as an adjunct for short-term risk stratification of patients with PD being considered for DBS treatment.

Sustained improvement of obsessive–compulsive disorder by deep brain stimulation in a woman with residual schizophrenia

Co-occurrence of obsessive–compulsive disorder (OCD) and schizophrenia is not rare (Eisen et al., 1997). Given that the obsessional content is not related to psychotic subject matter, both disorders can be regarded as delimitable diagnostic entities (Bottas et al., 2005). Recently, a number of case reports and small case series have demonstrated that deep brain stimulation (DBS) targeting the fronto-striato-thalamic circuit can have beneficial effects on OCD (Abelson et al., 2005; Greenberg et al., 2006; Sturm et al., 2003). DBS treatment of patients with current or past psychotic disorders has not yet been reported. Here, we present a comprehensive clinical evaluation of a woman with intractable OCD and residual symptoms of schizophrenia that were treated with unilateral DBS of the right nucleus accumbens (NAc), including neuropsychological long-term follow-up, neurophysiological measurements and functional brain imaging. This 51-yr-old right-handed woman suffered from a severely disabling, chronic and intractable form of OCD with excessive hand washing, cleaning, rearrangement of objects and compulsory praying [Yale–Brown Obsessive Compulsive Scale (YBOCS) score 32/40, 1 month prior to treatment]. Psychosocial functioning as measured by the GAF (Global Assessment of Functioning) scale was severely impaired (31/100). The symptoms started during childhood and accumulated during her early twenties. Obsession consisted of preoccupation with thoughts about guilt and purgation. Later in the course of the disease, psychotic symptoms (delusions, hallucinations, disorganized behaviour) meeting DSM-IV criteria for schizophrenia occurred transiently. The remaining presence of a few odd beliefs, minor paranoid ideation and disorganized behaviour in an attenuated form that were unrelated to the obsessions and compulsions led to the diagnosis of residual schizophrenia according to DSM-IV using SCID (Structured Clinical …